Prophylactics aren’t expected to be particularly pretty, but no one wants to have sex looking like they’re wearing their grandmother’s rain slicker. That may be why the female condom, available since the late 1990s, has never caught on in the U.S. The fact that it is visible may be a turn-off for some. But women may want to reconsider: after all, the rain-gear look trumps facing unwanted pregnancies or STDs…

The female condom — marketed as the FC — may not be alluring, but it puts protection directly into the hands of women. Produced by the Female Health Company, the FC is one of four barrier birth control methods, the other three being the cervical cap, the diaphragm and the sponge. Of these, only the FC can prevent both sexually transmitted diseases (STDs) and pregnancy when properly used.

Unfortunately, the female condom has not caught on in the United States or abroad, despite the hopes of European health officials that it would help fight the AIDS epidemic.

What the FC Can Do for You

Unsightly or not, the FC has many advantages: Most important, it helps women prevent both infection and unplanned pregnancy. Of every 100 users, about 21 will become pregnant during the first year of use. But only five will become pregnant with perfect use, a rate similar to that of other barrier methods, albeit less effective than the male condom.

A 6.5-inch polyurethane pouch with a flexible ring at each end resembling a diaphragm, the FC is also easy to use. The closed end of the female condom – which is lubricated to ease placement – can be inserted into the vagina up to eight hours before intercourse. The open-ended ring extends outside the vaginal opening, making the FC easy to remove and discard after each use. It doesn’t have to be taken out immediately, but the female condom is only recommended for use during a single sex act. The ring at the closed end holds the FC in place while the ring outside the vagina helps guide insertion and keeps the condom from bunching up inside. (See related article: Contraceptives 101)

Don’t use the female condom if your partner is wearing a male condom. The friction between the polyurethane and the latex can undercut any protection.

FCs are readily available and affordable – about $2.50 each in the United States. And people who are allergic to latex can use them. Currently, 14 million female condoms are distributed annually to women in poor countries. By comparison, between 6 and 9 billion male condoms are distributed each year. So why hasn’t the female condom achieved the same level of popularity as the male condom?

Not So Sizzling Style

In the United States, complaints about the female condom are largely aesthetic. Many find it to be ugly and awkward to use. It has an unnatural feel and makes noise during sex, though this problem can be lessened with additional lubrication.

Resistance by women in third world countries also stems from the fact that the FC is visible during intercourse. In many cultures, a wife’s use of protection during sex suggests infidelity, which can create a volatile domestic situation. Those who use them are usually prostitutes. Consequently, female condoms account for only 0.2% of global condom use.

The Female Health Company redesigned its original FC, and in 2005 introduced a product called the FC2. Made from a nitrile polymer, the FC2 boasts a thinner, more compliant material than polyurethane with a more natural feel. The FC2 is coated with a silicone-based lubricant to ease insertion and allow for smoother movement during intercourse. The FC2 is cheaper than the original and offers a non-allergenic barrier to STDs, including HIV. The FC2 is seeking FDA approval. (See related article: 6 STD Myths Debunked)

A new female condom design has also been developed by the Program for Appropriate Technology in Health (PATH), a non-profit group in Seattle, and has a smaller insertion end the size of a tampon. It also features softer, thinner polyurethane that moves more naturally and dots of foam that adhere to the vaginal walls and allow the condom to expand along with the vagina during arousal. PATH’s female condom has not yet received approval by the FDA for sale in the U.S., but 90% of couples who tested the product reported satisfaction, ease of use and comfort.

Rough Road to Approval

Despite the improvements, redesigns of the female condom still have problems to sort out. In 1999, the FDA adopted a much more stringent test for approval. The male condom is considered a Class 2 medical device (meaning it must pass leakage and bursting tests). However, the female condom is now considered a Class 3, meaning it must pass costly clinical trials due to a lack of clinical data on its effectiveness for preventing STDs and HIV. The rating (the same held by pacemakers, heart valves and silicone breast implants) is a huge setback to its acceptance.

The FC2 has received a CE mark indicating that the product can be marketed in Europe. And the World Health Organization has recommended that United Nations agencies purchase FC2s to use in more than 80 developing countries. The FC is known by several different brand names in other countries including Reality, Femidom, Dominique, Femy, Myfemy, Protectiv’, and Care.

Another version called the VA feminine condom is manufactured by Medtech Products Ltd. and Intellx Inc. It is not available in the United States, but has gained the CE mark allowing distribution in the European Union. The VA, also called Reddy female condom and V-Amour, has also been distributed in South Africa since 2004 as part of HIV prevention efforts.

Similar to male condoms, the lubricated VA is the first female condom made of latex. It has a sponge at the closed end, anchoring it inside the vagina. Only water-based lubricants can be used with latex: Oil-based products can damage the latex, leading to leaks and tears.

How to Use the FC

Lie down, squat or sit – whatever’s comfortable. Hold the ring at the closed end of the FC with the open end hanging down. Squeeze the ring with your thumb and middle finger just as you would with a diaphragm, so the ring becomes long and narrow. Insert the ring and sheath into your vagina. Place your index finger inside and push the inner ring up as far as it will go, making sure the condom is straight and not twisted. The outer ring should be outside the vagina. When you are ready for intercourse, guide your partner’s penis into the ring and sheath. If the condom slips or the outer end enters the vagina, stop intercourse and take the FC out; then slip on a new one.

After intercourse, gently twist the outer ring and pull the condom out. Be careful to keep the sperm inside. Wrap the FC in toilet paper and put it in a wastebasket, not down the toilet.

Available Alternatives

Barrier methods such as the cervical cap, the diaphragm and the sponge also have drawbacks but a much higher rate of acceptance than the female condom. None will prevent STDs, and two of the three require the addition of a spermicide. (The exception is the sponge, which is infused with spermicide that is activated with moisture before insertion.) A health care professional must fit you for the cervical cap and diaphragm to ensure proper placement for protection.

Each of the barrier types can come loose during intercourse, and the sensation of a foreign body during sex can distract even the most devoted partner. The expense of the alternates makes them prohibitive in developing countries. So, many advocacy groups are working to advertise the advantages of the newly designed FC2, hoping that usage rates will eventually rise.

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